1. Field of the Invention
The present invention relates generally to apparatus and methods for performing arthroscopic shoulder surgery, and more particularly to a surgical operating table and method for performing shoulder arthroscopy with a patient in a sitting position.
2. Description of the Prior Art
The use of shoulder arthroscopy as a therapeutic and diagnostic tool has dramatically increased over the past decade. Patient recovery time is much shorter when arthroscopy is used as compared with open surgery, and shoulder arthroscopy has become particularly popular for sports-related shoulder injuries. Unfortunately, progress in shoulder arthroscopy has been hampered because of difficulty in positioning and stabilizing the patient's shoulder, while still allowing full exposure to all aspects of the shoulder and free movement of the arm.
Shoulder arthroscopy is usually performed with the patient under general anesthesia, lying in the lateral decubitus position, with the arm in traction to distend the shoulder joint. Such positioning and the application of such traction are generally shown in Pitman, et al., "The Use of Somatosensory Evoked Potentials for Detection of Neuropraxia During Shoulder Arthroscopy", Arthroscopy, Vol 4, No. 4, 1988, pages 250-255, and in Klein, et al., "Measurement of Brachial Plexus Strain in Arthroscopy of the Shoulder", Arthroscopy, Vol. 3, No. 1, 1987, pages 45-52. The lateral decubitus position requires that the operating table be essentially flat and horizontal. The patient is rolled on one side with the affected shoulder being uppermost, with the patient's back essentially perpendicular to the table, and with the lower leg flexed at the thigh and knee to stabilize the pelvis. Although the lateral decubitus position provides good access to the shoulder including the posterior aspect, the traction apparatus interferes with manipulation of the arm. The traction force causes distortion of the capsular anatomy, compromising arthroscopic visualization and impeding surgical technique, especially capsuloplasty. Also, the traction usually has to be adjusted intraoperatively to visualize the subacromial space, a cumbersome task. Finally, mechanical arm traction can cause neurological compromise and complications.
Shoulder arthroscopy can be performed with the patient in the semirecumbent position. For example, in Skyhar, et al., "Shoulder Arthroscopy with the Patient in the Beach-Chair Position", Arthroscopy, Vol. 4, No. 4, 1988, pages 256-259, the authors report on the use of a so-called "beach-chair sitting position" for shoulder arthroscopy. This position uses gravity assist for distraction of the joint and allows for gentle precise manipulation of the joint. However, to gain adequate access to the posterior aspect of the joint, the patient's torso must be pulled over the edge of the table and then rotated upward and supported in this awkward position with various supports such as beanbags, sandbags, blanket rolls, arm boards, or other outriggers. This position is precarious at best, and during the course of the operative procedure, the patient usually derotates with resultant loss of posterior exposure of the shoulder. Furthermore, with the patient in this position, the acromion is inclined posteriorly resulting in upward angulation of the arthroscope especially when performing a bursascopy. This position allows escaping saline to run down the arthroscope, not only fogging the lenses of the arthroscope and television camera, but also draining onto the surgeon's legs and feet and onto the floor.
Accordingly, it is an object of the present invention to provide an apparatus and method for performing shoulder arthroscopy which positively positions the patient in a stable manner without the need for sandbags, beanbags, blanket rolls or the like, and without the interference of ropes, pulleys, or other mechanical arm traction devices.
It is another object of the present invention to provide such an apparatus and method which provide ready access to the posterior aspect of the shoulder, while permitting convenient manipulation of the patient's arm.
Still another object of the present invention is to provide such an apparatus and method which do not require that the patient be pulled or rolled over the edge of a surgical table in order to gain access to the affected shoulder.
A further object of the present invention is to provide such an apparatus and method which permit for conversion to an open surgical procedure without the necessity of changing patient position, and without the necessity for reprepping and draping of the patient.
A still further object of the present invention is to provide a surgical table particularly facilitating arthroscopic shoulder surgery while still permitting other types of surgery to be performed thereon.
Yet another object of the present invention is to provide such an apparatus and method wherein the positioning of the patient upon the surgical table is fast, simple, and performed mechanically rather than by direct manual manipulation of the patient.
Still another object of the present invention is to provide such an apparatus and method which facilitates anesthesia of the patient.
Another object of the present invention is to provide such an apparatus and method which place the patient's acromion in a near horizontal plane for allowing the arthroscope to remain in a horizontal position.
These and other objects of the present invention will become more apparent to those skilled in the art as the description of the present invention proceeds.